Locally advanced rectal cancer in a patient with ectopic kidney: case report and literature review

The coexistence of ectopic kidney with locally advanced rectal cancer is rare. It poses a surgical and oncological challenge for the treating team. Careful preoperative surgical planning and decision about the neoadjuvant treatment are paramount.We report a 40-year-old male newly diagnosed with rectal adenocarcinoma with ectopic kidney. His preoperative staging was T3N2M0 with ectopic malrotated left kidney. After discussion in the multi-disciplinary team meeting, decision was to omit the neoadjuvant treatment and to go for low anterior resection. The procedure started open, and the findings showed the kidney lying in retroperitoneum around 3 cm above the peritoneal reflection and was separable from the tumor. Oncological resection of the rectosigmoid colon by lateral to medial approach with separation and preservation of the kidney, an end-to-end stapler anastomosis followed with a protective loop ileostomy. The patient had a smooth postoperative course, and the final pathology was T3N1Mx. He received eight cycles of adjuvant XELOX and was free of diseases on 1 year follow-up. There is no optimal option in managing this scenario due to a highly variable blood supply of the ectopic kidney and rarity of this condition. Multi-disciplinary team meeting with preoperative radiological mapping and patient counseling is crucial in making the best decision.